Women face disadvantages in healthcare — and how some PBMs are attempting to fill the gaps

Editor’s note: This article was previously published on the MHE website as a two-part series on Sept. 17, 2026.

In many ways, the deck is stacked against women when it comes to healthcare in the U.S. Women are less likely to have employer-based health insurance, which tends to have better benefits. Some research has shown that women have higher out-of-pocket costs. Screening rates among women for several important health conditions, such as cardiovascular disease, lag behind those for men. Women live longer, on average, than men, but they tend to spend more years in poor health.

Women also face access challenges for many medications. The pharmaceutical consulting company ZS has suggested that women face a double standard, with coverage being considered a “nice to have.” Pharmacy benefit coverage decision makers, according to research done by ZS, were less likely to cover a women’s health product. Even when a women’s health product is considered clinically valuable, a higher bar is often needed to put such products on the formulary.

Some pharmacy benefit managers (PBMs) are beginning to help employers and plans address the access to, affordability of and adherence for women’s health medications. LucyRx, for example, has been focused on women’s health, cardiovascular health and menopause almost from the beginning of the company’s founding
in 2023.

Access, affordability, adherence and care navigation are cohesive components of prescription care, says Susan Thomas, MBA, chief commercial officer at LucyRx. “This can’t be looked at as transactional anymore,” she said. “Pharmacy is a whole-member health benefit. Benefits can cover the right medications, but if the member can’t afford it, if they don’t understand it, if they have side effects, or if they can’t even find their medication, then the benefit
falls short.”

Why there are gaps

Women’s health has attracted unprecedented attention in the past few years, yet investment, particularly in life sciences, continues to lag, says Maria Whitman, MBA, managing partner of ZS’ global commercialization strategy. “In our research and work with clients, we saw signals that access may be the point where many women still encounter the biggest barriers.”

Double standards often aren’t recognized, says Barrett Pignone, M.S., co-founder and co-lead of ZS’ Women’s Health Expertise Hub. “Payers in our study were quick to say they didn’t have bias within their own company, yet through a resume test where they looked at either a women-indicated product or a men’s indicated product, fewer payers were highly likely to cover the women’s health product.”

Many women, Whitman said, experience delays in diagnosis, treatment hurdles and challenges obtaining prescribed therapies. This is true whether women need access to birth control, infertility treatment or support for pregnancy or menopause.

“It’s less about the individual disease areas and more about making changes to the overall system, which was built around assumptions that don’t fully reflect women’s experiences,” she observes. “It’s not about special treatment for women; it’s about ensuring that healthcare systems are designed for the patients they actually serve.”

Access barriers, however, don’t start at the pharmacy counter. “They begin when women struggle to be believed, diagnosed, treated and ultimately covered,” Whitman says.

Scientific innovation, she adds, only matters if patients can actually receive treatment when they need it, citing Zurzuvae (zuranolone) as an example. Zurzuvae is the first oral therapy to treat women with postpartum depression. It launched in December 2023 with a list price of
$15,900 for a 14-day course of treatment. In 2025, more than 6,600 prescriptions were shipped and delivered.

The drug’s manufacturer, Sage Therapeutics, said in 2025, more than 95% of people with commercial and Medicaid plans are covered or have a path to coverage, with the majority having no step edits or complex prior authorizations. But Whitman points out that Zurzuvae must be ordered through a specialty pharmacy, which can impact access. “This is more than a minor inconvenience; PPD [postpartum depression] is time sensitive and all-encompassing for that individual,” she says.

Using quantitative and qualitative research, ZS’ study looked to understand potential gaps in payer decision makers’ willingness to cover women’s health treatments. Although the study did not include PBM leaders directly, it did include payer decision makers serving on pharmacy and therapeutics committees at their organizations.

“We saw that they were less likely to cover women's health products compared with men’s health products when all things, including cost, were equal,” says Ailie Reasons, MBA, co-founder and co-lead of ZS’ Women’s Health Expertise Hub. The study found that a personal familiarity with a condition may influence how decision makers perceive a treatment’s importance. If the decision maker has less personal familiarity with a condition, they can unintentionally undervalue the treatment’s importance.

PBMs can help employers and health plans to view women's health not as a niche benefit category but as a population health and workforce productivity strategy. “Improving women's health isn't just good medicine; it can have ripple effects across families, workplaces and overall healthcare utilization,” says Pignone.

MHE survey of PBMs about their women’s health programs

Managed Healthcare Executive conducted an informal survey of PBMs to determine which types of support they provide for women’s health. What we found is that many PBMs have programs that are still in a pilot phase or just getting off the ground. They range from support for fertility drugs and maternity care to expanded formulary access to hormones or medications for hot flashes and support for women with cancer and cardiovascular diseases. Here is how three PBMs described their women’s health programs to us.

Judi Health: A flexible benefit

Rather than offering a single program, Judi Health lets employers and health plans customize benefits based on the unique needs of their members while integrating specialized women's health partners. One partnership Judi has is with Progyny, which provides comprehensive fertility and family-building support. Judi Rx partners with Progyny on a per-employee-per-month basis to offer personalized fertility, maternity and menopause solutions.

Members typically verify eligibility through their employer-sponsored health plan and are then connected with a dedicated Progyny care advocate who assists with onboarding, provider selection, treatment coordination and ongoing support.

One client with approximately 30,000 covered lives experienced 64.4% lower multiple birth rates, 27.1% higher live birth rates and 33.2% fewer retrievals per live birth. Lower multiple pregnancy rates are associated with improved maternal and neonatal outcomes, while higher live birth rates reflect greater treatment effectiveness and efficiency of care, according to a Progyny spokesperson.

LucyRx: Focused on women’s health

LucyRx has been focused on women’s health, cardiovascular health and menopause almost from the beginning of the company’s founding in 2023. This focus on women’s health was formed after the wife of a company executive who was not on the company’s plan had difficulty accessing hormone replacement therapy (HRT); that plan required $300 out of pocket for the medications prescribed by her doctor, says Thomas.

“I thought that doesn’t make any sense, and when I looked up her formulary, it was excluded,” she adds. “I realized then we need to build a better way. Women should not have to jump through hoops to get their HRT. We set out on evaluating the market and formularies and why drugs were excluded. LucyRx then began a strategy around access, affordability and navigation.”

LucyRx’s strategy aims to make access easier. There is no new-to-market block on new estrogen products or medications such as Veozah (fezolinetant) or Lynkuet (elinzanetant), which address the hot flashes that can accompany menopause.

LucyRx has also made its prior authorization simpler, with most first-line therapies covered. Importantly, LucyRx helps clients to understand their whole population within a plan, and spend and find the care gaps. The Lucy IQ tool can help to find sponsors and understand the specific gaps in that population and the recommendations to close them, notes Thomas.

LucyRx has a no-cost program, LucyRx Women’s Health Benefit, which offers an expanded formulary that includes hormone replacement and other related therapies. “We look at the women's health benefit more as a gap-in-care product, not a savings product,” Thomas says.

The Women’s Health program is part of an optional Care Guides program that launched in January 2026 for an additional cost to clients. This program provides nurse and pharmacist support to help patients start and stay on treatment. Care Guides can coordinate with prescribers and pharmacies until specialty therapy is active and scheduled, line up refills and enroll eligible members in manufacturer copay support and patient assistance programs.

Thomas said the Care Guides program has 60% to 70% engagement rates when a client opts in; the company is striving for 80% in high-risk, high-volume, cost-sensitive areas. The Care Guides program is offered with a guaranteed 2.5:1 to 3:1 return on investment. This could lead to $1.4 million to $2.4 million in annual pharmacy savings, depending on the sponsors’ own data.

Most contraception, she says, is now generic and covered as a standard benefit on tier 1. Although the nonprescription Opill is not covered by their standard formulary, LucyRx would do the financial modeling if a sponsor were interested in providing coverage for
that product.

Coverage of fertility drugs would also only be covered if a client selects that option. “We don't see many clients covering fertility under the pharmacy benefit. It is an active pipeline in our women's health product evolution,” Thomas says. “Fertility drugs would be dispensed from a specialty pharmacy. Many plan sponsors will put a cap on the benefit if they are covering it under the pharmacy benefit.”

RxPreferred: Fertility medications at a discount

In 2026, about 40% of U.S. organizations offer fertility, family planning and family support benefits, which is a decrease from 42% in 2024, according to the 2026 Benefits Survey conducted by the International Foundation of Employee Benefit Plans.

There are a lot of gaps in coverage for fertility, Meagan Williams, vice president of enterprise strategy at RxPreferred, says. “About 88% of all of these plans have what’s called a lifetime maximum, or a cap of dollars that they would include for an IVF [in vitro fertilization] treatment or infertility treatment. And those that are covering IVF oftentimes are for the procedure or the consultation, but not the medication.”

She said the cost for medications is approximately $3,000 to $8,000 on average for one cycle without genetic testing. “Many families require more than a round of treatment; the average is 2.3 rounds to achieve a live birth,” Williams said. “The average lifetime cap for coverage is $16,000.”

Williams says RxPreferred wanted to figure out how it could close the gap on medication access and provide medications at a discount. This comes at a time when states and even the federal government have identified access to fertility treatment as a priority. When TrumpRx, the direct-to-consumer option for prescription drugs, launched in February 2026, several IVF drugs from EMD Serono were included.

RxPreferred began a pilot program offering My-RXP, a separate fertility benefit for both clients and nonclients that provides access to fertility medications and services. RxPreferred is now launching this program nationwide. In the pilot program, RxPreferred assisted 700 rounds of
IVF treatment.

Williams says the My-RXP program takes a personalized approach, with clinical pharmacists meeting with patients to make recommendations based on the patients’ history